Perceptions of Dementia, Caregiving and Help Seeking among Asian and Pacific Islander Americans

Article excerpt

Alzheimer's disease, which causes progressive memory loss and dependence, is estimated to affect 4 million Americans (Yeo & Gallagher-Thompson, 1996). Social workers, regardless of setting in which they work, will find themselves working with more families affected by this disease. At the same time, the United States is becoming more ethnically diverse, and social workers are seeking to broaden their understanding of culturally diverse views of specific health problems, the family's role in providing care, and how help is sought. In an attempt to help expand knowledge in this area, this article pulls together findings from the literature and from research in Honolulu on the perceptions of five Asian and Pacific Islander (API) American groups - Chinese, Japanese, Filipino, Vietnamese, and Native Hawaiian - on dementia, caregiving, and help seeking. Implications for practice, policy, and research are discussed.

ASIAN AND PACIFIC ISLANDER AMERICAN POPULATION

Asian and Pacific Islander (API) Americans are the third largest ethnic minority group in the United States, numbering about 7.3 million in 1990 (U.S. Bureau of the Census, 1991a, 1991b). Among residents age 65 and older, the API elderly group is the fastest growing, projected to have more than tripled between 1980 and 1995 (Young & Gu, 1995). Far from being a homogeneous group, the API label encompasses more than 30 distinct ethnocultural entities, each with its own language and customs (Wykle & Kaskel, 1991).

Among the largest Asian American groups are Chinese, Filipino, Japanese, Koreans, and Vietnamese. Their immigration patterns were influenced by U.S. labor needs and foreign policy. Chinese, Japanese, Korean, and Filipino immigrants initially came to fill low-paying jobs, especially in California and Hawaii, but their immigration was curtailed by the Oriental Exclusion Act of 1924. Immigration rules were relaxed during and following times of war when foreign brides of U.S. servicemen and citizens of countries who helped the U.S. cause were allowed to enter the country. The Immigration Act of 1965 liberalized U.S. immigration policy, allowing 20,000 immigrants per year per country, regardless of race or ethnicity, for purposes of occupational immigration (if their skills are needed in the U.S. labor market), family reunification, and vulnerability to political and religious persecution. Because unmarried children under age 21, spouses, fiancees, and parents of U.S. citizens are exempt from the quota limitation, each country can actually send more than 20,000 immigrants per year (Min, 1995).

Among Pacific Islander Americans, the largest groups are Native Hawaiians and Samoans (Young & Gu, 1995). Both of these groups became Americans by virtue of colonization. The Kingdom of Hawaii was overthrown by the U.S. military in 1893 and was administered by the U.S. Department of the Interior until it became a state in 1959 (Blaisdell & Mokuau, 1991). American Samoa became a U.S. Territory in 1900. It was first administered by the Department of the Navy as a coaling station; later it came under the Department of the Interior. American Samoa elected its first governor in 1977 (McDermott, Tseng, & Maretzki, 1980).

The API American group has been called a "model minority" because, as a whole, data on social status suggest that API Americans are better educated and better off financially than other ethnic minority groups (Gelfand, 1994; Markides, 1987; U.S. Department of Health and Human Services, 1985). Researchers who have taken a closer look at the data, however, have found extreme unevenness within the API designation. For example, the 1980 census indicated that a good proportion of API American households had annual incomes of $50,000 or higher; but at the same time, a greater percentage had incomes at or below poverty level compared to European Americans (LinFu, 1988; Liu & Yu; 1985). U.S. residents of Samoan and Southeast Asian descent have been found to be at particularly high risk of poverty (Morioka-Douglas & Yeo, 1990). …